Complications of low compared to standard pneumoperitoneum pressures in laparoscopic surgery for benign gynecologic pathology: a systematic review protocol

Abstract

BackgroundNo definite consensus has been established about the optimal pressure for artificial pneumoperitoneum when performing laparoscopic surgery. It has been postulated that lowering intra-peritoneal pressure levels while performing general laparoscopic surgery would lower surgical complications including post-operative pain, but data remain scarce about significant operative complications. Furthermore, such data is not available for gynecologic laparoscopy. The objective of this systematic review is to compare the frequency and nature of significant operative complications of lower and standard pneumoperiteoneal pressure levels in gynecologic laparoscopic surgery for benign indications.Methods/designWe will search PubMed, Embase, the Cochrane Library, randomised control trials registries, and reference lists of included articles. Randomised controlled trials comparing different intra-peritoneal pressure levels in women undergoing gynecologic laparoscopic surgery for a non-malignant indication will be eligible. Two reviewers will independently select and review references, extract data, and assess quality from included studies. We will use RevMan5 to calculate risk ratios and their 95 % confidence intervals to compare the frequency of complications according to intra-peritoneal pressure levels. We will perform sensitivity analyses to explore heterogeneity potentially due to various operative characteristics or characteristics of patients.DiscussionOur results will help identify the optimal intra-peritoneal pressure level in gynecologic laparoscopic surgery and determine if lowering intra-peritoneal pressure levels while trying to achieve lower levels of post-operative pain is an acceptable change of practice according to the frequency and nature of significant complications.Systematic review registrationPROSPERO: CRD42015020231Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0091-6) contains supplementary material, which is available to authorized users.

Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review

“… 17 , 19 – 21 We included all randomized controlled trials comparing at least two different intraperitoneal pressures during gynecologic surgery without regard to language, date of publication, or the characteristics of the patients, enhancing the validity, precision, and generalizability of our results. Our systematic review was conducted according to our previously published protocol, 18 which confers enhanced validity to our methodology.…”

“…The search strategy used for Medline is available in our previously published protocol. 18 Keywords and index terms related to laparoscopy and artificial peritoneal pressures were used. Validated filters 19 , 20 were used to discriminate randomized controlled trials.…”

Послеоперационная Боль У Пациенток После Лапароскопических Операций В Гинекологии

“…Кроме того, таких данных совсем немного для проведения гинекологической лапароскопии, при которой позиция и оперативные манипуляции отличаются от общей лапароскопической хирургии. Оптимальное искусственное внутрибрюшное давление должно обеспечивать хорошую визуализацию и уровень безопасности во время операции при минимальных интра-и постоперационных осложнениях [9]. Целью нашего исследования были определение влияния давления пневмоперитонеума на расход анестетиков и опиоидов, восстановление пациенток после лапароскопического вмешательства и раннюю послеоперационную боль.…”